Lecture 35: Clinical Evaluation of balance Flashcards
Balance is made up of…..
Balance made up of:
- Ocular cues
- Proprioception
- Vestibular system
What does Vestibular System Do?
- Sense of position
- Gaze stabilisation
What do you do in a Clinical testing with a patient who may have impaired vestibular system?
- History
- Ear examination (e.g. cholesteatoma)
- Eye movements (e.g. nystagmus or smooth pursuit)
- Head thrust
- Fukuda (Unterberger) stepping test
- Fistula test
- (press into their ear, and they get dizzy)
- Dix Hallpike
- Laboratory
- Audiogram
- Optokinets
- Caloris
- Computerised head thrust
- vEMP
What History should you take for someone with vertigo?
- True vertigo or not (exclude after effects)
- Episodic nature (on/off, or continuous)
- Duration of vertigo (minute, hours, days)
- 1 minute = Benign paroxysmal positional vertigo (BPPV) or vestibular migrane
- Hours = meniyere’s, acoustic myoma
- Days = Vestibular neuronitis
- Precipitating factors: (what brings this on)
- Head movement
- Loud noise
- Diving/valsalva
- Migraine
- Associated factors:
- Migraines
- Tinnitus
- Hearing loss
- Aural fullness
- Stroke
Draw the flow diagram to diagnose the cause of vertigo
(real life application)
What are the 3 semi-circular canals equivalent to in real life?
This, but it doesn’t detect detect acceleration and gravity.
What detects linear acceleration?
Utricle(horizontal) and Saccule(vertical)
Little crystals are embedded into the matrix.
When you go up and down the elevator, the crystals (are heavier) so it displaces the matrix.
What are the sensory structures in the vestibular system?
- 1) Ampulla of the semicircular canals
- detects movement of fluid
- 2) Dilated end of canal
- 3) Contains sensory neuroepithelium, cupula, supporting cells
- Cupula is gelatinous mass extending across at right angle
- it extends completely across, not responsive to gravity
- Crista ampullaris is maded up of sensory hair cells and supporting cells
Each afferent neuron has a baseline firing rate
- Deflection of _______towards ______ increase in firing rate of afferent neuron
- Deflection ______causes a decrease in firing rate
Each afferent neuron has a baseline firing rate (left figure)
- Deflection of stereocilia towards kinocilium increase in firing rate of afferent neuron
- Deflection away causes a decrease in firing rate
Kinocilia are located _________
Kinocilia are located closest to utricle in lateral canals and are on canalicular side in other canals (right figure)
- Amupllopetal flow (toward the ampulla) are excitatory in lateral canals, inhibitory in superior/posterior canals
- Ampullofugal flow (away from the ampulla) has opposite effect
- _____________(toward the ampulla) are excitatory in later canals, inhibitory in superior/posterior canals
Kinocilia are located closest to utricle in lateral canals and are on canalicular side in other canals (right figure)
- Amupllopetal flow (toward the ampulla) are excitatory in later canals, inhibitory in superior/posterior canals
- __________flow (away from the ampulla) are inhibitory in later canals, excitratory in superior/posterior canals
Kinocilia are located closest to utricle in lateral canals and are on canalicular side in other canals (right figure)
- Amupllopetal flow (toward the ampulla) are excitatory in later canals, inhibitory in superior/posterior canals
- Ampullofugal flow (away from the ampulla) has opposite effect
- Amupllopetal flow (toward the ampulla) are _____________
- Ampullofugal flow (away from the ampulla)___________
- Amupllopetal flow (toward the ampulla) are excitatory in later canals, inhibitory in superior/posterior canals
- Ampullofugal flow (away from the ampulla) has opposite effect
Vestibulo-Occulular Reflex _______
the goal is to ________
VOR stabilizes images on the retina
The goal is for eye movement to be equal and opposite to the head movement
COWS (Cold Opposite, Warm the Same)
Peripheral vestibular malfunction usually means ______function (rarely hyperfunction)
Peripheral vestibular malfunction usually means reduced function (rarely hyperfunction)